Electronic Health Record - NIATx

enginestagNetworking and Communications

Oct 26, 2013 (3 years and 10 months ago)

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Behavioral Health providers are being challenged to adopt health
information technology with very limited resources. There is a
need to prepare for increased numbers of patients receiving health
insurance benefits, requirements for electronic billing, data
exchange among treating providers and an ever increasing need to
collect and use health information to improve care.



These intense one day seminars will provide attendees with the
necessary information to move forward in adopting, acquiring and
implementing electronic health records and other health
information technology. Presenters will review the various stages
of implementation from initial planning and assessment through
advanced topics such as data warehousing. There will be a focus
on utilizing networks of care to build on economies of scale.
Participants will leave with a thorough understanding of where
they are in the process, and a plan for next steps in their health
information technology implementation efforts
.


These seminars are a collaborative work of
NIATx
, SAAS and

The National
C
ouncil supported by SAMHSA.










Topics include:



Overview of the CMS Rule on Medicare and Medicaid
Incentive Payments


Practice Management Systems
vs

EHRs


Benefits & Economies
of Scale when working with a
Network


HIT Planning and Assessment
Process


HIT Workflow
Redesign


Due Diligence and Vendor
Negotiations


EHR Selection and
Implementation


Disaster Recovery and Business Continuity
Planning


Data
Warehousing


Use of
Telemedicine


Health Information Exchange and Behavioral
Health




HIT Planning & Assessment
Process


Health Information Technology

The Planning & Assessment Process


To achieve a successful transition from paper charts to the
electronic health record (EHR) requires a commitment from the
entire organization, a distinct willingness to change processes
and adequate resources. As with any information technology
implementation careful consideration must be given to the
readiness of an organization for significant workflow and
process change. Lack of preparation has been a serious
contributor to the unusually high failure rate of EHR adoptions.



This presentation will provide the attributes you will need to
achieve a successful EHR implementation with an
understanding of the areas for assessment and preparation.
You will be exposed to assessment tools easily acquired on the
internet, and you will receive a demonstration of an
assessment tool being used today by one of the nation's
regional extension centers.

5

1.
Lack of alignment with
business strategy

2.
Weak executive
-
level
sponsorship

3.
Underestimating impact on
organization

4.
No readiness assessment for
change

5.
Unrealistic expectations

6.
Lack of an effective, cross
-
functional implementation team


7.
No definition or measures
for progress or success

8.
No organized mechanism for
communication and
feedback

9.
Lack of formal training plan

10.
Lack of effective physician
leadership

*

EHR does not meet core
provider needs

Top 10 Reasons for EHR Adoption Failure

6

Readiness Attributes


Alignment

Organizational Alignment


Culture
: values; environment for achieving excellence;
ability to manage change and maintain flexibility; team
approach


Organization
: infrastructure to support information flow,
decision making, and problem resolution; role of the board
and leadership team; vision for quality; ability to
collaborate with external organizations


Leadership
: the characteristics of leadership team: setting
vision, commitment to quality; alignment across
organization


Strategy
: mission and vision and priorities documented in
a strategic plan; internal and external communications

7

Readiness Attributes


Capacity

Management Capacity


Information Management
: quality, accessibility,
relevance and communication of data/information


Clinical and Administrative Staff
: staff capacity;
staff training and competence; consistent policies
and procedures; methods to motivate and drive
individuals/groups to achieve goals


Accountability
: how results are achieved and
mission/vision fulfilled; role and responsibility of
patient in care process


Finance & Budget
: extent of infrastructure and
management of IT budget; capital and operational
resources

8

Readiness Attributes


Capacity

Operational Capacity


Workflow Process
: tools and methods for
managing change, developing policies, procedures,
protocols; Quality Improvement model; process for
monitoring and communicating performance;
analysis and actions taken to improve processes
and performance


Patient Involvement
: preventative and chronic care
processes; patient follow
-
up and care continuum;
comprehensive care


Training:

Infrastructure and resources dedicated to
initial and on
-
going IT training

9

Readiness Attributes


Capacity


Technical Capacity


IT Management and Support
: IT staff skill
-
set and
capacity for IT management and support;
consistent policies and procedures


IT Infrastructure:

information systems environment
and infrastructure


10

11

Goals of having a solid planning strategy

Identify the range of tasks typically performed in an EHR implementation
and the steps necessary to prepare for a successful EHR
implementation.

Explain the key components of a successful implementation plan.

Describe how to engage users in the system build process to achieve
EHR goals.

Identify the key components of a successful system build.

Explain strategies to minimize go live anxiety, from rehearsal, pre
-
live, to
go
-
live.

Understanding the “Best Practices”.

Issue Management & the escalation process from a HCCN perspective.

11

Project Timeline Strategy Example

Practice Management:


Week 1: Schedule Kick
-
off call

Week 2: Billing discovery call

Week 2
-
6: Hardware approval, Return IT Inventory checklist

Week 5
-
7: Install check

Week 9
-
12: Application Installation

Week 10
-
11: Attend billing & system setup training

Week 12
-
14: Mock go
-
live

Week 15
-
16: On
-
site training & go live

*Does not include a data migration or clinical/financial conversion


12

Project Timeline Strategy Example

Electronic Health Record (EHR):


Week 1:

Schedule Kick
-
off call: Provide milestone dates & intro to implementation
process.

Week 2:

EHR system setup: Setup of the tables & customization of EHR

Week 2
-
6:

Lab Interface serialization: Enroll, serialize lab portal services

Week 5
-
7:

Patient portal / Secure messaging setup
-

If applicable for sharing &
communicating information with your patient in a secure forum.

Week 9
-
12:

Training: Web
-
training, onsite training, self paced computer based
training (CBT’s)

Week 10
-
11:

Go
-
Live: Onsite point of care shadowing

Week 12
-
14:

Post go
-
live support: Typically occurs 60
-
90 days after go
-
live. Revisit
practice flow, best practices, & lessons learned.




13

Conducting a successful pre
-
EHR
assessment

How will EHR change your day?


Current practice review:




Review & refine practice workflows and identify areas for process improvement.



Make necessary workflow & process improvements.


Future improvement considerations:




How will using the EHR at the point of care alter the workflow?



What tasks can be combined once an EHR is in place?



What changes will result from improving workflow and how will the practice
manage the change?

14

15

Conducting a successful pre
-
EHR
assessment

15

Conducting a successful pre
-
EHR
assessment



Assessment Phase



Assessing practice’s cultural readiness and IT proficiency



Developing a vision for the project



Determining a budget



Creating a project team



Organizational Readiness



Cultural



Leadership



Operational



Technical


16

Tools for a Successful Assessment

PaperTracer
....

Was
adopted as our

Business
Process Management
Software.

It allows us to
easily use our SQL Modules
& Assessment Tools to
deploy powerful
custom
SQL databases
, make them
collaborative

with both
internal and external users,
personalize with your
Corporate Logo.

17

18

Tools for a Successful Assessment

PaperTracer
....

Allows us to
“Add” data related to the
practice directly into a
predefined web URL that can
be accessed online.

18

19

Tools for a Successful Assessment

Allows us to capture existing
computer infrastructure,
existing server
configurations, and computer
acumen. The database is
completely customizable and
allows for real time client
recommendations as a
deliverable report.

19

20

Tools for a Successful Assessment

Allows us to present and
mitigate risk. This data can
then be used in the client
deliverable report and
<click> presentation of data

20

Tools for a Successful Assessment

Allows us to export data
directly into a stoplight report
as a portion of the client
deliverable.


The tool allows us to be
vendor agnostic and provide
factual data that can be used
in identifying the best EHR
System for the client needs.

21

The Psychology of Change Management

22

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24




Questions?

25

Original Content Developed for
SAMHSA by


26

www.southfloridarec.org

www.hcnetwork.org

28

Our Footprint


HCCN
-

Member Center CEOs
serve as Board of Directors


41 member centers in 10 states
(FL, HI, KS, MD, MO, NM, RI, TX,
UT, WV)


Approximately 800,000 patients
with more than 2 million visits


Covering Priority Primary Care
Providers (PPCP) in Miami
-
Dade,
Broward, Monroe, Martin, Palm
Beach, Indian River,
Okeechobee, and St. Lucie
Counties


Provider Goal = 2,500

29

HCN Health Information Technology Services


Electronic Health Record


Medical / Dental / Behavioral


Custom Provider Templates


School Based Dental


School Based Medical


Document Imagining


Voice Recognition


CCD



Network Administration


Hosting Services


Back office / Email Support


Disaster Preparedness


Infrastructure Design
(LAN/WAN)


Web Design/Mgmt


Implementations and Training


Project/Change Management


Training and Staff Development


Best Practices Matrix


Reimbursement Coordination



Support Services


24hr Service Desk (Hardware/Software)


Project Management


Vendor Escalation


BETA Testing



Business Intelligence


Meaningful Use Reporting


Clinical Reporting


Fiscal Reports (Black Book)


Web based Reporting Tools


Practice Management Support


Headquartered in Portland, Oregon, OCHIN is a national non
-
profit collaborative, currently comprised of
42 organizations across seven states representing over 400 clinics and over 2,000 providers. With the
ultimate goal of transforming health care in the United States, OCHIN provides integrated HIT software
products and a wide variety of services, training and education to community health clinics,

mental
health services and small practices serving the medically underserved.


www.ochin.org



32

Who We Are


501c(3)
Collaborative Health
Center Controlled
Network


51% of Board Members are Community Health Center Executives


42 member organizations, over 400 individual clinics & 2000 providers


1M patients, 2.140M Practice Management & 1.712M Electronic Health Record annual visits













33

OCHIN PRODUCTS AND SERVICES


Practice Management


Scanning solutions


FQHC customizations


Special and community Library
Reports


Flexible build and configuration


Automated patient notifications


Revenue cycle management



Electronic
Health
Record


Integrated community health record
-

medical, dental, behavioral health,
school
-
based clinics


E
-
prescribing


Decision
s
upport tools


Case/care management tools


I
ntegrated lab interfaces


Advanced role based security


Voice
r
ecognition


Reporting and benchmarking tools


Document management


Continuity of Care Record (CCD)


Patient Personal
H
ealth
R
ecord (PHR)




Implementation, Training and Products


Project management


Information systems implementation


Network design


HIT integration & interoperability


Billing and revenue cycle management


Staff PM/EHR training


Web
-
based training modules



Support


Project Management


24/7 service desk


Advisory and consulting services


Meaningful Use reporting tools


Clinical reporting tools


Specialty build for grant


Vendor escalation





Practice Based Research Network


Safety Net clinical research &
clinical collaboration opportunities








34

www.AdvanceHealthIT.org

Regional Extension Center

Est. 2010

www.CHCAlliance.org

Health Center Controlled Network

Est. 1999

35

Core Health Information
Technology

Offerings


Practice Management System
(including Practice Analytics)


Electronic Health Records


(240,000+ Patient Records)


ePrescribe


Lab Orders / Results


Specialty Provider Referrals


Quality Reporting


Electronic Oral Health
Records

(including Digital Imaging)

“Meaningful” Users of EHR Since 2005

Professional Services


Project Management / Implementation Support


Leadership and task level monitoring


End to end project / system design


Workflow / Process Consideration


On
-
site Go
-
Live Choreography


Training


Modalities matched to provider / end user needs,
including classroom, coaching, and web
-
based tools


Competency exams


Report Writing / Administration


Custom QA/QI, Peer Review, and Operations reporting


Meaningful Use


Workflows, Provider
-
level detail, and
gap analysis


EHR Development / Enhancement


Clinical Committee directed


Interface management to support HIE and other
functionality to the provider desktop


Technical Assistance & Support


Help Desk processes more than 7,000 requests
annually; fewer than 5% escalated to vendors


24x7 System Availability


Tier 1 Data Center Partner


Server Redundancy


Privacy / Security Monitoring & Management


24x7 Server Monitoring / Network Administration

36

Service Area Counties:

41

Provider Goal:
2,026


Education and Trusted Resource for
Latest Information


Best Practices Dissemination


System selection assistance


System implementation support


Technical assistance


Privacy and security best practices


Workflow redesign


Clinical outcomes reporting / data
integrity


Federal regulations navigation


“Meaningful Use” education,
application, and attainment


Education and assistance in achieving
eligibility for CMS EHR Adoption
Incentive Program funding
(Designed to
help overcome the financial barrier to
EHR adoption)